Pleura and Smoking Effects- Parks and Baker Flashcards by Danielle Hayes

What are the more common congential anomalies?

agenesis or hypoplasia of the lungs
foregut cysts
pulmonary sequestration

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What causes agenesis or hypoplasia of the lungs (one lung or single lobes)?

caused by anything that impedes normal lung expansion in utero

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What causes foregut cysts?

abnormal detachment of primitive foregut

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What is pulmonary sequestration?

Where is it located?

lung tissue without connection to the airway system

-Can be internal to lung (intralobar) or external to lung (extralobar)

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What is resorption atelectasis?

What is the most common cause of resorption atelectasis?

atelectasis that occurs when an obstruction prevents air from reaching distal airway. Get resorption of trapped O2 and then atelectasis
-obstruction of a bronchus by a mucous or mucopurulent plug. (typically occurs postoperatively)

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What is ths:
airless pulmonary parenchyma?
How do get it?

atelectasis “collapsed lung”

neonatal, form incomplete expansion
aquired

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What are the three ways to acquire atelectasis?

resportion
compression
contraction

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What is resportion atelectasis?

airway obstruction leads to resoprtion of O2 within the alveoli

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What are three ways you can get resportion atelectasis?

Secretions 
-mucous plugs
-exudates
Aspiration of foreign body
Neoplasm

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What diseases cause the secretions that cause resorption atelectasis?

astham, chronic bronchitis, bronchiectasis

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What is compression atelectasis and what is it due to?

compression of pleural cavity (potential space between the visceral and parietal pleura of the lungs) due to fluid, tumor, blood, air (pneumothorax)

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How do you get contraction atelectasis?

from pulmonary fibrosis

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Does atelectasis cause post-op fever?

not really

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What are the five 5 W’s of post op fever?

Wind (pneumonia…used to be that atelectasis was classic)
Water (UTI)
Wound (surgical site infection)
Walking (DVT/PE)
Wonder Drugs (Drug or other iatrogenic cause)

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WHat is the pleura?

has a visceral and parietal surface that encloses each long.
It is a potential space with approx 15 mL of lubricating serous fluid.

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Most pleura disease is (blank) to some other disease. What is the exception to this?

secondary

Mesothelioma

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How do you get pleuritis from pneumonia?

you get serous fluid into pontential pleura space and then pleuritis

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What is this:
any excess accumulation of pleural fluid
Is it symptomatic or asymptomatic?
What causes this?

pleural effusions
Can be both
Can be a variety of causes

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Exudative effusions tend to be (blank)

And transudative effusions tend to be (blank)

inflammatory

non-inflammatory

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What are transudative effusions associated with?

"non inflammataory"
hydrostatic mechanism
-heart failure
-renal failure
-liver failure

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What are exudative effusions associated with?

“Inflammatory”

Infections
Malignancies
Immune responses (Rheum)
Noninfectious inflammations
Trauma

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What is the light’s criteria?

It determines whether a fluid is exudative or transudative

ProteinF/ProteinS > 0.5
LDHF/LDHS > 0.6
Serum LDH > 2/3 of the upper limit of normal for serum

Presence of any of these criteria is positive

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What is the sensitivity/specificity of the light’s criteria for determining if a fluid is exudative?

Sensitive but not very specific

need to use clinical judgment to diagnose

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What is this;
-inflammation of the pleura

What causes it?

Pleuritis

-infection (local or systemic), Rheumatologic, metastatic disase, radiation exposure

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What are the inflammatory effusions?

pleuritis | empyema

What is a purulent pleural exudate? How do you find it in the body? What is the etiology?

- empyema - loculated (formed in small pockets) - usually contiguous spread (pneumonia), but can come from a distant source

What are the dangers of empyema?

the purulence may resolve but can also organize and cause permanent respiratory restriction

What are the three non-inflammatory effusions?

- hydrothorax - hemothorax - chylothorax

What does the fluid look like in a hydrothorax? What is it associated with? What is it usually caused by?

Clear/straw-colored fluid pulmonary edema cardiac failure

What is a hemothorax and what is it caused by?

frank blood in the pleural space | typically from trauma/vascular space

What is a chylothorax and what is it caused by?

milk, lymphatic fluid | thoracic duct trauma, obstruction (cancer?) with secondary lymph rupture

Wht is a pneumothorax? What is it most commonly associated with? How else can you get it?

air in the pleural space - emphysema, asthma, TB - Trauma - Spontaneous Idiopathic Pneumothorax

How can trauma cause a pneumothorax?

perforating injury to the chest wall

How can a spontaneous idiopathic pneumothorax result? | Who does it occur in?

- due to rupture of small peripheral blebs (often recurrent) | - relatively young people

What is a tension pneumothorax?

progressive worsening of pneumothorax

What is a tension pneumothorax associated with?

mechanica ventilation (positive pressure)

How do you diagnose a tension pneumothorax?

clinically (not radiographic)

How do you clinically diagnose a tension pneumothorax?

-no breath sounds, hyper-resonance to percussion, contralateral deviation of the trachea/mediastinum

What happens to cardiac ouput with tension pneumothorax?

reduced CO -> medical emergency

Where do you do a needle thoracostomy to remedy a tension pneumothorax?

anterior 2nd intercostal, mid-clavicular line

Which pleural tumors are more common, primary or secondary?

secondary tumors (metastatic) MUCH MORE COMMON

What are the most common causes of secondary pleural tumors?

Lung and breast tumors (but could be any)

If you have a met to your lung how can you tell?

A met will cause a pleural effusion with positive cytology

Is malignant mesothelioma common? What is related in 90% of cases? What is the lifetime risk of getting malignant mesothelioma in patients who are heavily exposed to asbestos? Is risk worsened with smoking?

no it is uncommon Asbestos-related 7-10% No

How long is the latent period of malignant mesotheliom?

25-45 years long latent period

What is the presentation of malignant mesothelioma?

chest pain, dyspnea, recurrent pleural effusions | -20% have asbestosis also

What will malignant mesothelioma present as? | What is the death rate?

mets to the liver and other distant organs | -50% death rate in 12 months, rare survival after 2 years

Is malignant mesothelioma exclusive to pulmonary pleura?

NO! it can affect the peritoneum, pericardium as well as the pulmonary pleura

If you have a peritoneal mesothelioma, what does this indicate?

a particularly heavy exposure to asbestos (50% have coexisting asbestosis)

How do you check for malignancy?

order a cytology

CF is a disorder of ion transport in epithelial cells that affects fluid secretion in exocrine glands and the epithelial lining of the (blank X 3) Caused by a mutation in what gene? How common is it?

Respiratory GI Reproductive tracts CFTR, 1 in 2500 live births

Explain why your salty in CF?

NaCl channels are blocked so you sodium can leave the sweat duct lumen

Explain why your mucus is sticky and dry in cystic fibrosis?

your chloride channel is broken so you cant get chloride into the mucus thus your chloridestays in the epithelium creating a negative charge inside of it and thus sodium has to leave the mucus to neutralize the charge and brings water with it thus causing the dry mucus

How do you do a sweat chloride test?

a mild electrical current pushes medicine into skin to cause sweating. Sweat is collected and salt content is measured. (chloride and sodium is measured)

What is the most serious complication of CF?

pulmonary diseases such as bronchiectasis and colonization by resistant organisms (staph aureus/ pseudomonas)

What can the viscous mucus of CF cause?

bronchiectasis

What age group smokes the most? what gender? What education level? What race?

18-44 yrs men GED Native Am/Ala

What is the trend of tobacco use?

less people are smoking but the ones who are smoking are smoking more cigarettes than before

How many cigarettes are there in a pack?

What is the tobacco trend in males? | What is the tobacco trend in the femles?

males-> decreasing use with sharp decline | females-> leveled use with very slight decline

What is the leading cause of preventable death in the US?

smoking

Cigarettes are responsible for (blank) deaths annually

438,000 | more than HIV, illegal drug use, alcohol use, MVI, murders combined

Smoking accounts for (blank) percent of cancer cases. | How many cancer deaths does it cause?

25-30% | 170,000

``` Smoking causes (blank) percent of cases of lung cancer in men. Smoking causes (blank) percent of cases of lung cancer in females ```

90% | 78% (600% increase deaths in women since 1950)

What are the vascular affects of smoking?

- CAD (20% of all deaths from heart disease) - Cerebrovascular disease - Peripheral vascular disease - Abdominal aortic aneurysm

Who should you screen for abdominal aortic aneurysm?

men aged 65-75 | who have smoked >100 cigarettes in their life

Tobacco + OCP =?

MI, Stroke, Venous thromboembolism | especially greater than 35 yrs

What can smoking in pregnancy lead to?

low birthweight and prematurity

What are the benefits of quitting smoking?

- circ and lung function improves - 2.5 yrs cardiac events decreases to that of non smokers. - other cancer risks go fown - 15 yrs without smoking =risk for stroke approaches that of never smokers

After you quit smoking the chronic cough resolves or markedly improves in (blank)% of patients. (blank) patients experience resoltion in the first few weeks. SOB improves within (blank to blank) months

94-100% 1/2 1 to 9 months

When office staff asks about and documents smoking status… (blank) more likely that a physician will intervene. (blank) more likely that the patient will quit.

3x | 2x

What are the 5 A's?

``` ASK – about tobacco use ADVISE – to quit ASSESS – willingness to quit ASSIST – in quit attempt ARRANGE – follow-up ```

What are the 5 R's?

``` Relavance Risks Rewards Roadblocks Repeat ```

Physicians advice alone – increases rates of smoking cessation by (blank)

30%

Dont give (Blank) to a patient with kidney failure

IV contrast

Whats the trend of cigarette prices and sales?

increased prices and decreased sales